PREVALENCE OF HYPOGLYCAEMIA AMONG Plasmodium falciparum INFECTED WOMEN ATTENDING ANTENATAL CLINICS IN NSUKKA LOCAL GOVERNMENT AREA OF ENUGU STATE, NIGERIA

1.1         Introduction

Malaria is an old disease whose name is derived from the Italian (mal-aria) or “bad air” and it was also known as Roman fever, ague, marsh fever, periodic fever, paludism (Martin, 2003). There were numerous, sometimes bizarre theories on how malaria was transmitted until 1898 when Dr Ronald Ross discovered that the female Anopheles mosquito was actually responsible for transmitting malaria parasite. This discovery revolutionized malaria control, which had hitherto often been haphazard or based purely on treating the patient by killing the malaria parasites (Phillips, 2001; Cheesbrough, 2006). Malaria probably originated in Africa and accompanied human migration to the Mediterranean shores, India and Southeast Asia. In the past it used to be common in the marshy areas around Rome. As malaria is a disease mostly of tropical and subtropical areas, it is particularly prevalent in sub-Saharan Africa, but also common throughout other tropical regions of China, India, Southeast Asia, South and Central America (Cheesbrough, 2006). Nigeria’s quest for effective control of malaria began well before the WHO global malaria eradication period between 1955 and 1968 (Gilles et al., 2007). From 1955, however, a more focused egalitarian attempt at evolving strategic plans and interventions resulted in pre-eradication pilot studies such as the Kankiya District Project and the establishment of a division in Ministry of Health to deal with the mosquito and malaria problem. The National Malaria Control Committee (NMCC) was set up in 1975 with the set mandate to reduce the malaria burden by 25%. It produced a five year plan of action that terminated in 1980; however, it recorded only modest achievements. It took another 8 years before progress was made when a major health system reform was carried out in 1988, with the adoption of a Health Policy for the country. Within this Policy, malaria was to be eradicated using the concept of Primary Health Care. The Ministry of Health subsequently prepared guidelines for malaria control in 1989. Government finally came out with a National Malarial Control Plan of Action 1996. Past and present malaria control programme plan achieved limited success in eradicating the scourge. In spite of this, the malaria situation has steadily worsened and currently it is estimated that malaria accounts for 65 percent of all diseases reported in Nigeria health facilities and that 42% of pregnant women are diagnosed with malaria and affects the birth weight of infants (Akanbi et al., 2009).

Severe underreporting by patients and insufficient worldwide surveillance hampers epidemiological studies on the toll of malaria. Despite gross underreporting, the majority of cases and deaths are estimated to occur in sub-Saharan Africa, especially in children under 5 years of age (Sturchler, 1989; Snow et al., 1999; Brinkmann and Brinkmann, 1991). The World Health Organization (WHO) estimates that malaria caused 300-500 million infections, 100 million clinical cases (Plasmodium falciparum), and 1.5-2.7 million deaths in 1994 (WHO, 1997). The African malaria toll is difficult to quantify, and previous reports convey highly variable morbidity and mortality estimates from different estimation methods and from presumptive diagnoses that depend on often inaccurate febrile histories and clinical signs and symptoms without laboratory confirmation, and on estimates of transmission risks. With these qualifiers, WHO recognized that its mortality estimates could vary by a factor of 3 (WHO, 1997). Malaria has emerged as one of the top 10 killer diseases in the world. It is the major cause of mortality in tropical and subtropical regions. Majority of the cases as well as deaths occur in sub-Saharan Africa (Mishra et al., 2002). Malaria is essentially a tropical disease occurring in regions between latitudes 620N and 400S with an altitude of 1, 500 metres. This region is found mainly within the tropics and subtropics and this makes malaria endemic in this zone (Walter and Davis, 1976). There are two epidemiological extremes of malaria described as stable and unstable malaria (Butler et al., 1996). Climatic factors (relative humidity, altitude, rainfall level, mean temperature between 18-19oC) and socioeconomic factors (occupation, lifestyle, poverty) constitute the epidemiological factors of malaria endemicity in the tropics. All these factors have effects on the availability of vectors which maintain transmission of malaria (Butler et al., 1996).

The vector for malaria parasite is the female anopheles mosquito (Cheesbrough, 1998). Malaria transmission can be achieved by three known ways: vector transmission (Anderson et al., 1981), blood transfusion (Strickland, 1991) and congenital transmission (Ezechukwu et al., 2004). Malaria parasite interferes with three organs in the body, namely the brain, kidney and liver (Edington, 1967).

In all malaria-endemic countries in Africa, 25-40% (average 30%) of all outpatient clinic visits is for malaria (with most diagnosis made clinically). In these same countries, between 20% and 50% of all hospital admissions are a consequence of malaria. With high case-fatality rates due to late presentation, inadequate management, and unavailability or stock-outs of effective drugs, malaria is also a major contribution to deaths among hospital inpatients. This high burden may in fact be partly a result of misdiagnoses, since many facilities lack laboratory capacity and it is often difficult clinically to distinguish malaria from other infectious diseases. Nonetheless malaria is responsible for a high proportion of public health expenditure on curative treatment, and substantial reductions in malaria incidence would free up available health resources and facilities and health workers’ time, to tackle other health problems. Poor people are at increased risk both of becoming infected with malaria and of becoming infected more frequently. Child mortality rates are known to be higher in poorer households and malaria is responsible for a substantial proportion of these deaths.